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Kim S, Dowgwillo EA, Kratz AL. Emotional Dynamics in Fibromyalgia: Pain, Fatigue, and Stress Moderate Momentary Associations Between Positive and Negative Emotions. THE JOURNAL OF PAIN 2023; 24:1594-1603. [PMID: 37094743 PMCID: PMC10527274 DOI: 10.1016/j.jpain.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 04/03/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
Affective disruptions, particularly deficits in positive affect, are characteristic of fibromyalgia (FM). The Dynamic Model of Affect provides some explanations of affective disruptions in FM, suggesting that the inverse association between positive and negative emotions is stronger when individuals with FM are under greater stress than usual. However, our understanding of the types of stressors and negative emotions that contribute to these affective dynamics is limited. Using ecological momentary assessment (EMA) methods, 50 adults who met the FM survey diagnostic criteria rated their momentary pain, stress, fatigue, negative emotions (depression, anger, and anxiety), and positive emotions 5X/day for eight days using a smartphone application. Results of multilevel modeling indicate that, consistent with the Dynamic Model of Affect, there was a stronger inverse association between positive emotion and negative emotions during times of greater pain, stress, and fatigue. Importantly, this pattern was specific to depression and anger, and was not present for anxiety. These findings suggest that fluctuations in fatigue and stress may be just as important or more important than fluctuations in pain when understanding the emotional dynamics in FM. In addition, having a more nuanced understanding of the role that different negative emotions play may be similarly important to understanding emotional dynamics in FM. PERSPECTIVE: This article presents new findings on the emotional dynamics in FM during times of increased pain, fatigue, and stress. Findings highlight the need for clinicians to conduct a comprehensive evaluation of fatigue, stress, and anger in addition to more routinely assessed depression and pain when working with individuals with FM.
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Affiliation(s)
- Samsuk Kim
- Department of Psychology, University of Detroit Mercy, Detroit, MI
| | | | - Anna L. Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
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Pinto AM, Luís M, Geenen R, Palavra F, Lumley MA, Ablin JN, Amris K, Branco J, Buskila D, Castelhano J, Castelo-Branco M, Crofford LJ, Fitzcharles MA, Häuser W, Kosek E, López-Solà M, Mease P, Marques TR, Jacobs JWG, Castilho P, da Silva JAP. Neurophysiological and Psychosocial Mechanisms of Fibromyalgia: A Comprehensive Review and Call for An Integrative Model. Neurosci Biobehav Rev 2023:105235. [PMID: 37207842 DOI: 10.1016/j.neubiorev.2023.105235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 05/21/2023]
Abstract
Research into the neurobiological and psychosocial mechanisms involved in fibromyalgia has progressed remarkably in recent years. Despite this, current accounts of fibromyalgia fail to capture the complex, dynamic, and mutual crosstalk between neurophysiological and psychosocial domains. We conducted a comprehensive review of the existing literature in order to: a) synthesize current knowledge on fibromyalgia; b) explore and highlight multi-level links and pathways between different systems; and c) build bridges connecting disparate perspectives. An extensive panel of international experts in neurophysiological and psychosocial aspects of fibromyalgia discussed the collected evidence and progressively refined and conceptualized its interpretation. This work constitutes an essential step towards the development of a model capable of integrating the main factors implicated in fibromyalgia into a single, unified construct which appears indispensable to foster the understanding, assessment, and intervention for fibromyalgia.
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Affiliation(s)
- Ana Margarida Pinto
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal; University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; University of Coimbra, Psychological Medicine Institute, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal.
| | - Mariana Luís
- Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal.
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Martinus J. Langeveldgebouw, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, the Netherlands.
| | - Filipe Palavra
- Centre for Child Development, Neuropediatric Unit. Pediatric Hospital, Coimbra Hospital and University Centre, Avenida Afonso Romão, 3000-602 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Suite 7908, Detroit, MI 48202, USA.
| | - Jacob N Ablin
- Internal Medicine H, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel.
| | - Kirstine Amris
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Jaime Branco
- Rheumatology Department, Egas Moniz Hospital - Lisboa Ocidental Hospital Centre (CHLO-EPE), R. da Junqueira 126, 1349-019 Lisbon, Portugal; Comprehensive Health Research Center (CHRC), Chronic Diseases Research Centre (CEDOC), NOVA Medical School, NOVA University Lisbon (NMS/UNL), Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal.
| | - Dan Buskila
- Ben Gurion University of the Negev Beer-Sheba, Israel.
| | - João Castelhano
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Miguel Castelo-Branco
- University of Coimbra, Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), ICNAS, Edifício do ICNAS, Polo 3, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal, Portugal.
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
| | - Mary-Ann Fitzcharles
- Division of Rheumatology, Department of Medicine, McGill University, 1650 Cedar Ave, Montreal, Quebec, Canada, H3G 1A4.
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm 171 77, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Marina López-Solà
- Serra Hunter Programme, Department of Medicine and Health Sciences, University of Barcelona.
| | - Philip Mease
- Swedish Medical Center/Providence St. Joseph Health, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA.
| | - Tiago Reis Marques
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences (LMS), Hammersmith Hospital, Imperial College London, South Kensington, London SW7 2BU, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Strand, London WC2R 2LS, UK.
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
| | - Paula Castilho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal.
| | - José A P da Silva
- University of Coimbra, University Clinic of Rheumatology, Faculty of Medicine, Rua Larga - FMUC, Pólo I - Edifício Central, 3004-504 Coimbra, Portugal; Rheumatology Department, Coimbra Hospital and University Centre, Praceta Mota Pinto, 3004-561 Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (i.CBR), Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, 3000-548 Coimbra, Portugal
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Habibi Asgarabad M, Salehi Yegaei P, Jafari F, Azami-Aghdash S, Lumley MA. The relationship of alexithymia to pain and other symptoms in fibromyalgia: A systematic review and meta-analysis. Eur J Pain 2023; 27:321-337. [PMID: 36471652 DOI: 10.1002/ejp.2064] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 10/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE People with fibromyalgia (FM) often report having difficulty with emotional identification and expression, and this "alexithymia" may contribute to their pain and other symptoms. Multiple studies have assessed alexithymia in FM, and we systematically reviewed and meta-analyzed this literature to: (a) describe the prevalence of alexithymia in people with FM; (b) compare the level of alexithymia in FM to both healthy controls and controls with other pain conditions; and (c) determine the association of alexithymia to pain intensity, depression, and anxiety in people with FM. DATABASES AND DATA TREATMENT Following PRISMA guidelines, we searched multiple databases (Scopus, PubMed/MEDLINE, Embase, Web of Science, PsycINFO and Google Scholar) from inception to May 31, 2022. Study quality was assessed with The Joanna Briggs Institute (JBI) tools for cross-sectional studies, and STATA:17 was used for meta-analysis. A total of 32 studies met eligibility criteria and were included in meta-analyses. RESULTS The prevalence of alexithymia in FM averaged 48%. People with FM had substantially higher alexithymia than healthy controls (SMD = 1.00; 95% CI: 0.79 to 1.22), as well people with other pain-related conditions (SMD = 0.35, 95% CI = 0.04 to 0.65), particularly rheumatoid arthritis (SMD = 0.49; 95% CI: 0.08-0.91). Alexithymia was positively associated with pain intensity (r = 0.24), anxiety (r = 0.50), and depression (r = 0.41) among people with FM. CONCLUSIONS Due to the high level of alexithymia in people with FM and the positive relationship of alexithymia with pain and psychological distress, interventions to improve emotional awareness, expression, and processing in FM are recommended.
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Affiliation(s)
- Mojtaba Habibi Asgarabad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Health Promotion Research Center, Iran University of Medical Science, Tehran, Iran
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Psychiatric Institute), Iran University of Medical Sciences, Tehran, Iran
| | - Pardis Salehi Yegaei
- Health Promotion Research Center, Iran University of Medical Science, Tehran, Iran
| | - Fatemeh Jafari
- Department of Psychology, Faculty of Psychology, Islamic Azad University, Roudehen Branch, Roudehen, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Michigan, Detroit, USA
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Bains A, Kohrman S, Punko D, Fricchione G. A Link Between Inflammatory Mechanisms and Fibromyalgia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1411:357-378. [PMID: 36949318 DOI: 10.1007/978-981-19-7376-5_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Fibromyalgia (FM) is a condition characterized by chronic widespread pain, which has traditionally been considered psychogenic in nature due to lack of known underlying organic pathophysiology. In more recent years, inflammation of the nervous system has become increasingly recognized as a sign of neuropsychiatric conditions, and this association may enhance our knowledge of conditions such as FM. Emerging evidence has suggested inflammation, particularly neuroinflammation, as a potential contributor underlying the etiology of FM. Studies have searched for linked biomarkers with mixed results, though the literature is beginning to point to increased systemic levels of pro-inflammatory cytokines such as IL-6 and IL-8 in patients with FM relative to healthy controls. A multicenter imaging study has also reported results suggestive of microglial activation related to the presence of FM. Given the consistency in neuroinflammatory effects implicated in "sickness behavior" characteristic of chronic systemic inflammatory conditions such as cancer or rheumatic diseases, therein springs the hypothesis for a connection between FM and neuroinflammation as discussed in this chapter.
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Affiliation(s)
- Ashika Bains
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Avery Weisman Psychiatry Consultation Service, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Samuel Kohrman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Avery Weisman Psychiatry Consultation Service, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Diana Punko
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Avery Weisman Psychiatry Consultation Service, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Avery Weisman Psychiatry Consultation Service, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Benson-Henry Institute for Mind Body Medicine, Boston, MA, USA.
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Scarpina F, Ghiggia A, Vaioli G, Varallo G, Capodaglio P, Arreghini M, Castelnuovo G, Mauro A, Castelli L. Altered recognition of fearful and angry facial expressions in women with fibromyalgia syndrome: an experimental case-control study. Sci Rep 2022; 12:21498. [PMID: 36513716 PMCID: PMC9747799 DOI: 10.1038/s41598-022-25824-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022] Open
Abstract
Evidence relative to facial emotion recognition and the role played by alexithymia in fibromyalgia syndrome is rare and heterogeneous. In this work, we investigated this ability in fibromyalgia investigating the implicit behaviour in the facial emotion recognition task, focusing on fear and anger. Twenty women with fibromyalgia and twenty healthy women as controls performed a facial emotion recognition of fearful and angry expressions. Their implicit behaviour was scored in accordance with the redundant target effect. The level of alexithymic traits through a standard psychological questionnaire and its effect on behavioral performance were also assessed. Participants affected by fibromyalgia reported a lower level of accuracy in recognizing fearful and angry expressions, in comparison with the controls. Crucially, such a difference was not explained by the different levels of alexithymic traits between groups. Our results agreed with some previous evidence suggesting an altered recognition of others' emotional facial expressions in fibromyalgia syndrome. Considering the role of emotion recognition on social cognition and psychological well-being in fibromyalgia, we underlined the crucial role of emotional difficulties in the onset and maintenance of the symptoms life-span.
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Affiliation(s)
- Federica Scarpina
- "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Via Cherasco, 15, Turin, Italy.
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo (VCO), Italy.
| | - Ada Ghiggia
- Department of Life Sciences, University of Trieste, Via Edoardo Weiss 21, Trieste, Italy.
| | - Giulia Vaioli
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo (VCO), Italy
| | - Giorgia Varallo
- Dipartimento Di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Capodaglio
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Riabilitazione Osteoarticolare, Ospedale San Giuseppe, Piancavallo (VCO), Italy
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, Turin, Italy
| | - Marco Arreghini
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Riabilitazione Osteoarticolare, Ospedale San Giuseppe, Piancavallo (VCO), Italy
| | - Gianluca Castelnuovo
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo (VCO), Italy
- Dipartimento Di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Alessandro Mauro
- "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Via Cherasco, 15, Turin, Italy
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo (VCO), Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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Salaberria K, Ruiz‐Iriondo M, Pérez‐Fernández JI, Barandiarán A, Iruin A. Fibromyalgia and nonfibromyalgia chronic pain: Differences in psychological characteristics and treatment outcomes. Psych J 2022; 12:319-329. [PMID: 36403985 DOI: 10.1002/pchj.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/13/2022] [Indexed: 11/22/2022]
Abstract
The aim of this study was to explore differential psychological profiles among patients with chronic pain with and without fibromyalgia, and to determine the results of the cognitive behavioral therapy (CBT) for pain. Thirty patients with chronic pain and 60 patients with fibromyalgia were referred to 10 weekly sessions of CBT in a general hospital and were evaluated in pain-related variables, psychopathological symptoms, coping strategies, resilience, and quality of life. The program was implemented in specific groups for patients with fibromyalgia and nonfibromyalgia chronic pain. After the intervention, patients with fibromyalgia showed higher levels of psychopathology, rated their health status as poorer, and presented larger amplification of symptoms, higher levels of somatization, a more ruminating style of thinking and greater distress. Patients without fibromyalgia achieved better therapeutic results in both pain intensity (d = 0.39 vs. d = 0.12) and psychopathological distress (d = 0.77 vs. d = 0.11) compared to patients with fibromyalgia. Therefore, differential profiles and limited therapeutic results in fibromyalgia patients suggest the need to outline differentiated treatments and include other therapeutic strategies.
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Affiliation(s)
- Karmele Salaberria
- Department of Clinical and Health Psychology and Research Methods University of Basque Country San Sebastian Spain
- Neuroscience Department BIODONOSTIA Health Research Institute San Sebastian Spain
| | - María Ruiz‐Iriondo
- Neuroscience Department BIODONOSTIA Health Research Institute San Sebastian Spain
| | - José I. Pérez‐Fernández
- Department of Clinical and Health Psychology and Research Methods University of Basque Country San Sebastian Spain
- Neuroscience Department BIODONOSTIA Health Research Institute San Sebastian Spain
| | | | - Alvaro Iruin
- Neuroscience Department BIODONOSTIA Health Research Institute San Sebastian Spain
- Gipuzkoa Mental Health Network, Osakidetza‐Basque Health Service San Sebastian Spain
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Arfuch VM, Caballol Angelats R, Aguilar Martín C, Gonçalves AQ, Carrasco-Querol N, González Serra G, Sancho Sol MC, Fusté Anguera I, Friberg E, Berenguera A. Patients' Lived Experience in a Multicomponent Intervention for Fibromyalgia Syndrome in Primary Care: A Qualitative Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13322. [PMID: 36293900 PMCID: PMC9603341 DOI: 10.3390/ijerph192013322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Fibromyalgia syndrome (FMS) disrupts patients' biopsychosocial spheres. A multicomponent intervention (MCI) program, which combined health education, cognitive behavioral therapy, and physical activity, was conducted in South Catalonia's primary care centers with the aim of improving symptom self-management and quality of life. A qualitative interview study was carried out to understand patients' lived experiences during the intervention program. Sampled purposively, 10 patients were interviewed via phone calls and face-to-face. The encounters were audio-recorded, verbatim transcribed, and analyzed through thematic analysis. As a result, four themes emerged: legitimizing fibromyalgia through the MCI, the MCI as a socializing experience, learning how to live with FMS through the MCI, and room for improving the MCI. Participants agreed on the program being an insightful experience that promoted illness knowledge and acceptance and that improved their coping skills and symptom self-management. The inclusion of additional psychological guidance, expressive psychological group therapy, and providing relatives with information were proposed for enhancing the program. Our findings have contributed to gaining insight into the subjective impact of the MCI and identifying new therapeutic targets to tailor the program to patients' needs, which will hopefully increase its effectiveness and improve their quality of life.
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Affiliation(s)
- Victoria Mailen Arfuch
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
- Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine and Public Health Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 3 Berzelius väg Street, 6 Floor, 171 77 Stockholm, Sweden
| | - Rosa Caballol Angelats
- Centre d’Atenció Primària (CAP) El Temple, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), Plaça Carrilet sn., 43500 Tortosa, Spain
- Unitat d’Expertesa en Sindromes de Sensibilització Central Terres de l’Ebre, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
- Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
- Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L‘Ebre, Institut Català de la Salut (ICS), 44-58 Esplanetes Street, 43500 Tortosa, Spain
| | - Noèlia Carrasco-Querol
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
| | - Gemma González Serra
- Servei de Rehabilitació i Medicina Física, Hospital de Tortosa Verge de la Cinta, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), 44-58 Esplanetes Street, 43500 Tortosa, Spain
| | - Maria Cinta Sancho Sol
- Unitat d’Expertesa en Sindromes de Sensibilització Central Terres de l’Ebre, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
- Centre de Salut Mental d’Adults (CSMA) de Fundació Pere Mata Terres de l’Ebre, 50 Rambla de Pompeu Fabra, 43500 Tortosa, Spain
| | - Immaculada Fusté Anguera
- Centre d’Atenció Primària (CAP) El Temple, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), Plaça Carrilet sn., 43500 Tortosa, Spain
- Unitat d’Expertesa en Sindromes de Sensibilització Central Terres de l’Ebre, Gerència Territorial de Terres de l’Ebre, Institut Català de la Salut (ICS), 20 Cristòfol Colom Avenue, 43500 Tortosa, Spain
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 3 Berzelius väg Street, 6 Floor, 171 77 Stockholm, Sweden
| | - Anna Berenguera
- Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine and Public Health Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Central Research Unit, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Department of Nursing, Universitat de Girona, Plaça de Sant Domènec, 3, 17004 Girona, Spain
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8
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Hamdan-Mansour AM, Alsalman ET, Hamaideh SH, El-Kurdy R, Hamdan-Mansour LA. Psychological Predictors of Fibromyalgia Among High School Students. J Psychosoc Nurs Ment Health Serv 2022; 60:19-25. [PMID: 35412876 DOI: 10.3928/02793695-20220325-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to examine prediction power of psychological factors (i.e., alexithymia and psychological distress) on fibromyalgia among high school students. A cross-sectional, correlational design was used. Data related to alexithymia, psychological distress, and fibromyalgia were collected from 483 high school students from the northern part of Jordan using stratified cluster random sampling. Results showed that psychological distress is a significant predictor of fibromyalgia (odds ratio = 1.1, p < 0.001). Significant differences were found between males and females in relation to alexithymia (t = -4.87, p < 0.001), psychological distress (t = -6.0, p < 0.001), and fibromyalgia (χ2 = 4.14, p = 0.04, phi = 0.07). Age was only significantly correlated with alexithymia (r = 0.06, p < 0.05). Given the relationship among psychological distress, alexithymia, and fibromyalgia, mental health professionals should carefully observe psychological disturbances among high school students. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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Abstract
Facial emotion recognition (FER) is extensively investigated in psychological sciences in healthy individuals and clinical conditions. In this paper, we analyzed those studies in which FER was assessed in the case of obesity or fibromyalgia, in relation to the levels of alexithymia. Crucially, these two conditions frequently co-occur; however, no study has explored FER considering both fibromyalgia and obesity. Studies were identified using the electronic search engine of PubMed. The last research was run on 23 July 2021. Two independent lists were generated for the two clinical conditions. Six records were reviewed about obesity, while three records about fibromyalgia. The evidence relative to FER in obesity was not conclusive, whereas the evidence about an altered FER in fibromyalgia seemed more straightforward. Moreover, the role of alexithymia on FER in these clinical conditions was not extensively investigated. In our discussion, we highlighted those factors that should be carefully addressed in investigating FER in these clinical conditions. Moreover, we underlined methodological criticisms that should be overcome in future research.
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Lardone A, Turriziani P, Sorrentino P, Gigliotta O, Chirico A, Lucidi F, Mandolesi L. Behavioral Restriction Determines Left Attentional Bias: Preliminary Evidences From COVID-19 Lockdown. Front Psychol 2021; 12:650715. [PMID: 33935910 PMCID: PMC8080029 DOI: 10.3389/fpsyg.2021.650715] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
During the COVID-19 lockdown, individuals were forced to remain at home, hence severely limiting the interaction within environmental stimuli, reducing the cognitive load placed on spatial competences. The effects of the behavioral restriction on cognition have been little examined. The present study is aimed at analyzing the effects of lockdown on executive function prominently involved in adapting behavior to new environmental demands. We analyze non-verbal fluency abilities, as indirectly providing a measure of cognitive flexibility to react to spatial changes. Sixteen students (mean age 20.75; SD 1.34), evaluated before the start of the lockdown (T1) in a battery of psychological tasks exploring different cognitive domains, have been reassessed during lockdown (T2). The assessment included the modified Five-Point Test (m-FPT) to analyze non-verbal fluency abilities. At T2, the students were also administered the Toronto Alexithymia Scale (TAS-20). The restriction of behaviors following a lockdown determines increased non-verbal fluency, evidenced by the significant increase of the number of new drawings. We found worsened verbal span, while phonemic verbal fluency remained unchanged. Interestingly, we observed a significant tendency to use the left part of each box in the m-FPT correlated with TAS-20 and with the subscales that assess difficulty in describing and identifying feelings. Although our data were collected from a small sample, they evidence that the restriction of behaviors determines a leftward bias, suggesting a greater activation of the right hemisphere, intrinsically connected with the processing of non-verbal information and with the need to manage an emotional situation.
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Affiliation(s)
- Anna Lardone
- Department of Social and Developmental Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Patrizia Turriziani
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Pierpaolo Sorrentino
- Institut de Neuroscience des Systemès, Aix-Marseille University, Marseille, France
| | - Onofrio Gigliotta
- Department of Humanities, University of Naples Federico II, Naples, Italy
| | - Andrea Chirico
- Department of Social and Developmental Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Fabio Lucidi
- Department of Social and Developmental Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Laura Mandolesi
- Department of Humanities, University of Naples Federico II, Naples, Italy
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11
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Schmitz N, Napieralski J, Schroeder D, Loeser J, Gerlach AL, Pohl A. Interoceptive Sensibility, Alexithymia, and Emotion Regulation in Individuals Suffering from Fibromyalgia. Psychopathology 2021; 54:144-149. [PMID: 33951648 DOI: 10.1159/000513774] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION People suffering from fibromyalgia syndrome report various difficulties in emotional processing, possibly resulting from changes in bodily perception (interoception). In our study, we investigated the relationships between interoceptive sensibility (IS) and two disease-relevant emotional components (alexithymia and emotion regulation) in fibromyalgia sufferers compared to healthy individuals. METHODS Fifty-five fibromyalgia sufferers and 55 healthy individuals, matched with regard to age and gender, participated in our cross-sectional study. All participants completed the following self-report measures: the Multidimensional Assessment of Interoceptive Awareness, the Toronto Alexithymia Scale, and the Emotion Regulation Skills Questionnaire. Depression and anxiety scores served as confounding variables. RESULTS Fibromyalgia sufferers reported a stronger tendency to note as well as to avoid (unpleasant) body sensations. IS and psychopathology each explained about thirty percent of the variance in emotion regulation in fibromyalgia sufferers. Alexithymia was related to IS and emotion regulation in controls but not in fibromyalgia sufferers. CONCLUSION Disturbances in interoception could be seen as the starting point of emotional difficulties in people with fibromyalgia. Following the fear-avoidance-model, experiential avoidance may restrict patients' ability to adaptively regulate emotional states, possibly initiating a vicious cycle of psychological distress and pain.
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Affiliation(s)
- Natalie Schmitz
- Institute of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Jessica Napieralski
- Institute of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Dorothee Schroeder
- Pain Center of the Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany.,Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Johannes Loeser
- Pain Center of the Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany.,Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Alexander L Gerlach
- Institute of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Anna Pohl
- Institute of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
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12
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Ghavidel-Parsa B, Bidari A. Two sides on the fibromyalgia coin: physical pain and social pain (invalidation). Clin Rheumatol 2020; 40:841-848. [PMID: 32772267 DOI: 10.1007/s10067-020-05304-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 01/21/2023]
Abstract
Although fibromyalgia (FM) has been traditionally defined by the extent of physical pain sites alongside other non-pain symptoms, recent evidence has highlighted the importance of social dimension in definition of pain perception. Social pain or invalidation, which denotes painful feeling following social conflicts or misunderstanding about illness legitimacy, is an important but ignored issue in the FM lexicon. While physical and social pain seem to be different and separate entities, we hypothesize that they are completely intertwined with indistinct borders in FM. Accumulating emergent neuroscience and behavioral evidence highlights the overlapping of physical and social pain in different painful conditions. However, this overlapping seems to reach its maximum in FM. This review sheds more light on the tight interconnectivity between physical and social pain in FM from the perspective of intuitional commonalities, clinical aspects, and shared neural pathways. The conceptualization of FM as an integrative physical-social pain paradigm will move us closer to necessitating the incorporation of social pain in future models of FM diagnosis and management. Key Points • Considering of social pain as one key concept is relatively mute in FM literature. • Overlapping of physical and social pain seems to be unique in FM due to its nature. • Acknowledging social pain in the FM lexicon could shift the paradigm of diagnosis and management of FM patients.
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Affiliation(s)
- Banafsheh Ghavidel-Parsa
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Bidari
- Department of Rheumatology, Iran University of Medical Sciences, Hazarat Rasoul Medical Complex, Sattarkhan Ave, Tehran, Iran.
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13
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Alslman ET, Hamaideh SH, Bani Hani MA, Atiyeh HM. Alexithymia, fibromyalgia, and psychological distress among adolescents: literature review. Int J Adolesc Med Health 2020; 32:ijamh-2017-0081. [PMID: 32750034 DOI: 10.1515/ijamh-2017-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/18/2017] [Indexed: 11/15/2022]
Abstract
The purpose of this article is to review the literature regarding the relationships between alexithymia, fibromyalgia (FM), and psychological distress among adolescents. Google Scholar and databases were searched using alexithymia, fibromyalgia, psychological distress, and adolescent keywords. Studies that examine the relationship between alexithymia and fibromyalgia and the contribution of psychological distress on this relationship among adolescents are lacking. However, based on previous studies on adult samples and theoretical background, there are possible relationship between alexithymia and fibromyalgia as well as possible mediating effect of psychological distress on this relationship in adolescents. Further studies are recommended to examine the relationships between alexithymia, fibromyalgia, and psychological distress among adolescents.
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Affiliation(s)
- Eman Tariq Alslman
- Adjunct Faculty of Nursing, Oklahoma City University, Oklahoma City, OK, USA
| | - Shaher H Hamaideh
- Faculty of Nursing, Community and Mental Health Nursing Department, The Hashemite University, Zarqa, Jordan
| | - Manar Ali Bani Hani
- Director of National Emergency Medical Services Educational Center, Jordanian Royal Medical Services Amman, Jordan; and Faculty of Nursing, Albalqa Applied University, Amman, Jordan
| | - Huda Mohammad Atiyeh
- Health Educator, Ministry of Health-Princess Rahma Pediatric Teaching Hospital, Irbid, Jordan
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14
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Orrù G, Gemignani A, Ciacchini R, Bazzichi L, Conversano C. Machine Learning Increases Diagnosticity in Psychometric Evaluation of Alexithymia in Fibromyalgia. Front Med (Lausanne) 2020; 6:319. [PMID: 31998737 PMCID: PMC6970411 DOI: 10.3389/fmed.2019.00319] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/16/2019] [Indexed: 12/21/2022] Open
Abstract
Here, we report an investigation on the accuracy of the Toronto Alexithymia Scale, a measure to assess alexithymia, a multidimensional construct often associate to fibromyalgia. Two groups of participants, patients with fibromyalgia (n = 38), healthy controls (n = 38) were administered the Toronto Alexithymia Scale and background tests. Machine learning models achieved an overall accuracy higher than 80% in detecting both patients with fibromyalgia and healthy controls. The parameter which alone has demonstrated maximum efficiency in classifying the single subject within the two groups has been the item 3 of the alexithymia scale. The analysis of the most informative features, based on all scales administered, revealed that item 3 and 13 of the alexithymia questionnaire and the visual analog scale scores were the most informative attributes in correctly classifying participants (accuracy above 85%). An additional analyses using only the alexithymia scale subset of items and the visual analog scale scores has shown that the predictors which efficiently classified patients with fibromyalgia and controls were the item 3 and 7 (accuracy = 85.53%). Our findings suggest that machine learning models analysis based on the Toronto Alexithymia Scale subset of items scores accurately distinguish patients with fibromyalgia from healthy controls.
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Affiliation(s)
- Graziella Orrù
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Rebecca Ciacchini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Laura Bazzichi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ciro Conversano
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
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15
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Larice S, Ghiggia A, Di Tella M, Romeo A, Gasparetto E, Fusaro E, Castelli L, Tesio V. Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis. Scand J Psychol 2019; 61:271-280. [PMID: 31674683 DOI: 10.1111/sjop.12592] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022]
Abstract
Individual differences in emotional functioning, pain appraisal processing, and perceived social support may play a relevant role in the subjective experience of pain. Due to the paucity of data regarding individuals with Rheumatoid Arthritis (RA), the present study aimed to examine pain intensity, emotional functioning (psychological distress and alexithymia), pain appraisal (pain beliefs, pain catastrophizing, and pain-related coping strategies) and social support, and their relationships with the health-related quality of life (HRQoL) in patients with RA. Data were collected from 108 female patients diagnosed with RA. Clinically relevant levels of depressive and anxiety symptoms assessed by the HADS subscales were present in 34% and 41% of the patients, respectively, and about 24% of them exhibited the presence of alexithymia. The results of hierarchical multiple regression analyses showed that pain intensity, alexithymia, the maladaptive beliefs regarding the stability of pain and the coping strategy of guarding explained 54% of the variance in the physical component of HRQoL (p < 0.001). Depression subscale of the HADS, alexithymia, the coping strategy of resting, and the rumination factor of pain catastrophizing significantly explained 40% of the variance in the mental component of HRQoL (p < 0.001). The present findings provide evidence regarding the importance of emotional functioning and pain appraisal in the negative impact of RA on patients' quality of life. These findings provide additional evidence for the biopsychosocial model of chronic pain, further supporting the complex interaction between emotional, cognitive, and behavioral processes in patients with chronic pain.
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Affiliation(s)
- Sara Larice
- Department of Psychology, University of Turin, Turin, Italy
| | - Ada Ghiggia
- Clinical Psychology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | | | - Annunziata Romeo
- Clinical Psychology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Eleonora Gasparetto
- Clinical Psychology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Enrico Fusaro
- Rheumatology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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16
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Abstract
Background Fibromyalgia (FM) is a centralized pain state that until recently has been shrouded in mystery and questionable as a disease entity in the eyes of many physicians, who considered it purely psychogenic. Fibromyalgia is now thought of as a discrete diagnosis with a clustering of symptoms characterized by central nervous system pain amplification along with anergia, memory loss, disturbances of mood, and sleep disruption. The condition is present in approximately 2% to 8% of the population. Material/Methods We review the link between inflammatory mechanisms and FM from a neuropsychiatric perspective. Results Recent studies are pointing to a neuroinflammatory etiology that may open up more effective treatment strategies in the future. Conclusions Better conceptualization of FM may also elucidate a neuropsychiatric understanding of how nociception, dysthymia, and suicidality co-develop and feed off one another.
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Affiliation(s)
- Laura Duque
- Department of Psychiatry, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Gregory Fricchione
- Department of Psychiatry, Benson-Henry Institute for Mind Body Medicine, Boston, MA, USA
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17
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Sancassiani F, Preti A, Cacace E, Ruggiero V, Testa G, Romano F, Carta MG. Alexithymia and sense of coherence: Does their impact on fibromyalgia suggest new targets for therapy? Gen Hosp Psychiatry 2019; 59:78-79. [PMID: 30638611 DOI: 10.1016/j.genhosppsych.2018.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/29/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Affiliation(s)
- F Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Italy.
| | - A Preti
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - E Cacace
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - V Ruggiero
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - G Testa
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - F Romano
- Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Italy
| | - M G Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
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18
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Tesio V, Goerlich KS, Hosoi M, Castelli L. Editorial: Alexithymia: State of the Art and Controversies. Clinical and Neuroscientific Evidence. Front Psychol 2019; 10:1209. [PMID: 31178809 PMCID: PMC6543916 DOI: 10.3389/fpsyg.2019.01209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/07/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Katharina S Goerlich
- Department of Biomedical Sciences, Behavioural and Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Masako Hosoi
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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19
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Vucurovic K, Dupont-Gaudin C, Raucher-Chéné D, Kaladjian A, Cuervo-Lombard CV. Fibromyalgia patients make scarce reference to pain in self-defining memories. Compr Psychiatry 2019; 90:30-36. [PMID: 30684830 DOI: 10.1016/j.comppsych.2018.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Self-defining memories (SDMs) are vivid, emotionally intense and well-rehearsed autobiographical memories that provide fundamental information about one's cognitive affective motivational representation of self. Exploring SDMs in fibromyalgia (FM) is of interest for understanding the psychopathology of this disorder and improving clinical interventions. Our aim was to compare patients and healthy controls (HC) on SDM characteristics. METHOD We included 25 patients with FM and 24 HC matched for age, sex and education level. Each participant described five SDMs, which were coded for content, specificity, integration, tension, redemption, contamination, affective response, date, and reference to pain. We statistically controlled our results for the most plausible confounding factors related to FM that could affect SDM recall, namely depression, anxiety, cognitive inhibition, pain severity and medication. RESULTS Compared with HC, patients retrieved less specific SDMs with a more negative emotional valence but less tension. They reported more relationship-related memories, and fewer redemptive ones, with less meaning-making. The number of memories referring to physical or psychological pain did not differ between groups. None of the confounding factors we analysed could explain (either alone or in combination) the statistical differences between groups for SDMs characteristics. CONCLUSION We discuss functional avoidance and alexithymia as two main factors for poor reference to pain in patients' SDMs that further reveal affective dysregulation in FM. In clinical practice, remediating the way in which pain is integrated into SDMs in FM may help to mitigate its negative impact on everyday life.
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Affiliation(s)
- Ksenija Vucurovic
- Laboratoire Cognition, Santé, Société (C2S), Reims Champagne-Ardenne University, Reims, France; Department of Psychiatry, University Hospital, Reims, France.
| | | | - Delphine Raucher-Chéné
- Laboratoire Cognition, Santé, Société (C2S), Reims Champagne-Ardenne University, Reims, France; Department of Psychiatry, University Hospital, Reims, France
| | - Arthur Kaladjian
- Laboratoire Cognition, Santé, Société (C2S), Reims Champagne-Ardenne University, Reims, France; Department of Psychiatry, University Hospital, Reims, France
| | - Christine-Vanessa Cuervo-Lombard
- Department of Psychiatry, University Hospital, Reims, France; Centre for Studies and Research on Health Psychology and Psychopathology (CERPPS), Department of Psychology, Toulouse 2 Jean Jaurès University, Toulouse, France
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20
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Tesio V, Di Tella M, Ghiggia A, Romeo A, Colonna F, Fusaro E, Geminiani GC, Castelli L. Alexithymia and Depression Affect Quality of Life in Patients With Chronic Pain: A Study on 205 Patients With Fibromyalgia. Front Psychol 2018; 9:442. [PMID: 29670558 PMCID: PMC5893813 DOI: 10.3389/fpsyg.2018.00442] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/16/2018] [Indexed: 12/29/2022] Open
Abstract
Pain in fibromyalgia (FM) is accompanied by a heterogeneous series of other symptoms, which strongly affect patients’ quality of life and interfere with social and work performance. The present study aimed to evaluate the effects of alexithymia on both the physical and the psychosocial components of the health-related quality of life (HRQoL) of FM patients, controlling for the concomitant effects of depression, anxiety, and pain. In particular, given the strong interconnection between depression and alexithymia, the relationship between alexithymia and HRQoL as mediated by depressive symptoms was further investigated. Data were collected on a consecutive sample of 205 female patients with a main diagnosis of FM. The results showed that about 26% of the patients showed the presence of alexithymia, as assessed by the Toronto Alexithymia Scale (TAS-20). Clinically relevant levels of depressive and anxiety symptoms were present in 61 and 60% of the patients, respectively. The results of the hierarchical multiple regression analyses showed that pain intensity (PI) and depressive symptoms explained the 45% of the variance of the physical component of HRQoL (p < 0.001). Regarding the mental component of HRQoL, depressive and anxiety symptoms, alexithymia, and PI significantly explained 61% of the variance (p < 0.001). The mediation analyses confirmed that alexithymia had a direct effect on the mental component of HRQoL and showed a statistically significant indirect effect on both the physical and the mental components, through the mediation of depressive symptoms. In conclusion, the results of the present study suggested the presence of both a direct and an indirect effect of alexithymia, in particular of the difficulty identifying feeling, on the HRQoL of patients with FM. Indeed, even though the concomitant presence of depressive symptoms is responsible of an indirect effect, alexithymia per se seems to directly contribute to worsen the impact that this chronic pain pathology has on the patients’ quality of life, especially regarding the psychosocial functioning.
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Affiliation(s)
| | | | - Ada Ghiggia
- Department of Psychology, University of Turin, Turin, Italy
| | - Annunziata Romeo
- Department of Psychology, University of Turin, Turin, Italy.,Clinical Psychology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio Colonna
- Clinical Psychology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Enrico Fusaro
- Rheumatology Unit, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | | | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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21
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Ogrodniczuk JS, Kealy D, Joyce AS, Abbass AA. Body talk: Sex differences in the influence of alexithymia on physical complaints among psychiatric outpatients. Psychiatry Res 2018; 261:168-172. [PMID: 29309955 DOI: 10.1016/j.psychres.2017.12.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/19/2017] [Accepted: 12/30/2017] [Indexed: 11/16/2022]
Abstract
This study investigated the relationship between alexithymia and physical complaints among psychiatric outpatients, and whether sex moderated this relationship. Participants (N = 185) completed measures of physical complaints (bodily symptom burden, pain severity, pain interference), alexithymia, current symptom (depression, anxiety) distress, and somatosensory amplification (i.e., a person's tendency to be bothered by physical sensations). Hierarchical regression analyses were conducted, controlling for the influence of current psychiatric symptom distress and somatosensory amplification. Findings revealed differential relationships between alexithymia and physical complaints (pain interference) for women and men, in addition to main effects for sex and alexithymia. The findings suggest that the negative influence of alexithymia on bodily-related problems may not be universal.
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Affiliation(s)
- John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Anthony S Joyce
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Allan A Abbass
- Department of Psychiatry, Dalhousie University, Halifax, Canada
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22
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Sancassiani F, Machado S, Ruggiero V, Cacace E, Carmassi C, Gesi C, Dell'Osso L, Carta MG. The management of fibromyalgia from a psychosomatic perspective: an overview. Int Rev Psychiatry 2017; 29:473-488. [PMID: 28681628 DOI: 10.1080/09540261.2017.1320982] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fibromyalgia (FM) is a central sensitization syndrome characterized by chronic widespread pain. FM is often comorbid with psychiatric disorders, as well as psychological distress that worsens the quality-of-life of people affected. The aim was to collect current evidence about the management of FM from a psychosomatic perspective. The literature was synthesized and summarized in a narrative format. The literature search was carried out in PubMed; review articles, meta-analysis, overview, and guidelines published in the last 10 years written in English were included. Five main topics (Diagnostic criteria of FM; Pathogenesis of chronic widespread pain in FM; Early stress and trauma as predisposing factors for central sensitization; FM and Psychiatric comorbidity; Implications for treatment) were pointed out and discussed. Much evidence underlies the importance of considering and treating the comorbidity of FM with psychiatric disorders and psychological factors that affect pain management. Validation of FM as a central sensitization syndrome by a clinician facilitates therapeutic strategies that involve patients as active participants in the pain management process, likely leading to improved outcomes.
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Affiliation(s)
- Federica Sancassiani
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Sergio Machado
- b Laboratory of Panic and Respiration , Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , RJ , Brazil.,c Physical Activity Neuroscience , Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University , Niterói , Brazil
| | - Valeria Ruggiero
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Enrico Cacace
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
| | - Claudia Carmassi
- d Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Camilla Gesi
- d Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Liliana Dell'Osso
- d Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Mauro Giovanni Carta
- a Department of Medical Sciences and Public Health , University of Cagliari , Cagliari , Italy
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23
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Ghiggia A, Romeo A, Tesio V, Tella MD, Colonna F, Geminiani GC, Fusaro E, Castelli L. Alexithymia and depression in patients with fibromyalgia: When the whole is greater than the sum of its parts. Psychiatry Res 2017; 255:195-197. [PMID: 28577473 DOI: 10.1016/j.psychres.2017.05.045] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/12/2022]
Abstract
This study investigated the link between alexithymia and depressive symptoms in Fibromyalgia (FM). 181 FM women and 181 healthy controls (HC) were compared using the Hospital Anxiety and Depression Scale and the Toronto Alexithymia Scale. A moderation analysis was performed to examine the moderation effect of the group (FM vs. HC) on the relationship between alexithymia and depression. Group was a significant moderator, highlighting a stronger relationship between alexithymia and depressive symptoms in the FM compared to HC. The study highlighted that the association between alexithymia and depression is different when we consider FM patients rather than the healthy population.
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Affiliation(s)
- Ada Ghiggia
- Department of Psychology, University of Turin, Italy
| | | | | | | | - Fabrizio Colonna
- Clinical and Oncological Psychology, Department of Neuroscience, "Città della Salute e della Scienza" Hospital of Turin, Italy
| | | | - Enrico Fusaro
- Rheumatology Unit, "Città della Salute e della Scienza" Hospital of Turin, Italy
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Prise en charge des symptômes médicalement inexpliqués en médecine interne : un paradigme de la relation médecin-malade en situation d’incertitude. Rev Med Interne 2017; 38:458-466. [DOI: 10.1016/j.revmed.2016.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/17/2016] [Indexed: 11/18/2022]
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Saariaho AS, Saariaho TH, Mattila AK, Joukamaa MI, Karukivi M. The role of alexithymia: An 8-year follow-up study of chronic pain patients. Compr Psychiatry 2016; 69:145-54. [PMID: 27423355 DOI: 10.1016/j.comppsych.2016.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/24/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The aim of this 8-year follow-up study was to ascertain changes in alexithymia, depressiveness and pain situation in a sample of chronic pain patients and to explore the impact of alexithymia and depression on the outcome. METHODS Participants (n=83) were chronic non-malignant pain patients who completed self-report study questionnaires before their first visit to the pain clinic and again 8years later. Study variables consisted of pain intensity measured by the Visual Analogous Scale, the Pain Disability Scale, the Toronto Alexithymia Scale and the Beck Depression Inventory. The moderate improvement in the pain situation was estimated as a decrease of 30% or more in pain intensity or pain disability. RESULTS In the whole sample there was a significant decrease in pain intensity, pain disability and depressiveness, but only some of the patients achieved moderate improvement in their pain situation. Alexithymia remained stable during the 8-year period. The alexithymic patients had poorer pain situation and more depressiveness both at baseline and at follow-up. Unfavorable outcome in the pain situation was connected with male gender and alexithymia at baseline but not with depressiveness. Alexithymia and depressiveness were closely related to each other and the connection strengthened during the follow-up period. CONCLUSION Alexithymic depressive chronic pain patients represent a special, more disabled subgroup among chronic pain patients. The authors recommend screening for and identifying alexithymia and depression in chronic pain patients. Structural treatment protocols such as cognitive-behavioral therapy may benefit these patients. More research is needed to develop treatment interventions for alexithymic patients.
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Affiliation(s)
- Anita S Saariaho
- Pain Clinic, Raahe Hospital, P.O. BOXs 25, 92101, Raahe, Finland.
| | - Tom H Saariaho
- Pain Clinic, Oulu University Hospital, P.O. BOX 21, FIN-OUH, Oulu, Finland.
| | - Aino K Mattila
- Department of Psychiatry, Tampere University Hospital, P.O. BOXs 2000, 33521 Tampere, Finland.
| | - Matti I Joukamaa
- School of Health Sciences, Tampere University, 33014 Tampere, Finland.
| | - Max Karukivi
- Unit of Adolescent Psychiatry, Satakunta, Hospital District, Antinkatu 15A, 28100 Pori, Finland.
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Castelli L, Tesio V. Commentary: Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia patients. Front Psychol 2016; 7:740. [PMID: 27242640 PMCID: PMC4871879 DOI: 10.3389/fpsyg.2016.00740] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/04/2016] [Indexed: 12/02/2022] Open
Affiliation(s)
- Lorys Castelli
- Department of Psychology, University of Turin Turin, Italy
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Leombruni P, Zizzi F, Miniotti M, Colonna F, Castelli L, Fusaro E, Torta R. Harm Avoidance and Self-Directedness Characterize Fibromyalgic Patients and the Symptom Severity. Front Psychol 2016; 7:579. [PMID: 27199814 PMCID: PMC4842927 DOI: 10.3389/fpsyg.2016.00579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/07/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Evidence in the literature suggests peculiar personality traits for fibromyalgic (FM) patients, and it has been suggested that personality characteristics may be involved in patients' different symptomatic events and responses to treatment. The aim of the study is to investigate the personality characteristics of Italian FM patients and to explore the possibility of clustering them considering both personality traits and clinical characteristics. DESIGN The study used a cross-sectional methodology and involved a control group. A self-assessment procedure was used for data gathering. The study included 87 female FM patients and 83 healthy females. Patients were approached and interviewed in person during a psychiatric consultation. Healthy people were recruited from general practices with previous telephone contact. MAIN OUTCOME MEASURES Participants responded to the Hospital Anxiety and Depression Scale, the Temperament and Character Inventory, the Fibromyalgia Impact Questionnaire and the Short-Form-36 Health Survey. RESULTS FM patients scored significantly different from healthy participants on the Harm avoidance (HA), Novelty seeking (NS) and Self-directedness (SD). Two clusters were identified: patients in Cluster1 (n = 37) had higher scores on HA and lower scores on RD, SD, and Cooperativeness and reported more serious fibromyalgia and more severe anxious-depressive symptomatology than did patients in Cluster2 (n = 46). CONCLUSION This study confirms the presence of certain personality traits in the FM population. In particular, high levels of HA and low levels of SD characterize a subgroup of FM patients with more severe anxious-depressive symptomatology. According to these findings, personality assessment could be useful in the diagnostic process to tailor therapeutic interventions to the personality characteristics.
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Affiliation(s)
- Paolo Leombruni
- Department of Neuroscience "Rita Levi Montalcini", University of Turin Turin, Italy
| | - Francesca Zizzi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin Turin, Italy
| | - Marco Miniotti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin Turin, Italy
| | - Fabrizio Colonna
- Department of Neuroscience "Rita Levi Montalcini", University of Turin Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin Turin, Italy
| | - Enrico Fusaro
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Cittá della Salute e della Scienza di Torino Turin, Italy
| | - Riccardo Torta
- Department of Neuroscience "Rita Levi Montalcini", University of Turin Turin, Italy
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Evidence of Contrasting Patterns for Suppression and Reappraisal Emotion Regulation Strategies in Alexithymia. J Nerv Ment Dis 2015; 203:709-17. [PMID: 26252826 DOI: 10.1097/nmd.0000000000000353] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Alexithymia generally refers to difficulties in identifying and describing emotions. In this paper, two studies explored whether the emotion deficits observed in alexithymia may be related to the use of emotion regulation strategies. Relations with various sociodemographic variables were also explored. In the first study, 255 students completed the Emotion Regulation Questionnaire (ERQ) and the Toronto Alexithymia Scale-20. For the second study, 1107 participants from the general population completed the ERQ and the Bermond-Vorst Alexithymia Questionnaire. Results demonstrated that alexithymia was related to the use of a suppression strategy and in particular to difficulties verbalizing emotions, suggesting that the capacity to communicate and name one's emotion is a central aspect in alexithymia. Concerning sociodemographic variables, alexithymia and the use of a suppression strategy were found to be related to age and to be higher in males. The results of these studies and their clinical implications for treatment are discussed.
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Saariaho AS, Saariaho TH, Mattila AK, Karukivi M, Joukamaa MI. Alexithymia and Early Maladaptive Schemas in chronic pain patients. Scand J Psychol 2015; 56:428-37. [DOI: 10.1111/sjop.12226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 03/18/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Aino K. Mattila
- School of Health Sciences; Tampere University; Tampere Yliopisto Finland
- Department of Psychiatry; Tampere University Hospital; Tampere Finland
| | - Max Karukivi
- Unit of Adolescent Psychiatry; Satakunta Hospital District; Pori Finland
| | - Matti I. Joukamaa
- School of Health Sciences; Tampere University; Tampere Yliopisto Finland
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Neuroplasticity underlying the comorbidity of pain and depression. Neural Plast 2015; 2015:504691. [PMID: 25810926 PMCID: PMC4355564 DOI: 10.1155/2015/504691] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/10/2015] [Indexed: 02/07/2023] Open
Abstract
Acute pain induces depressed mood, and chronic pain is known to cause depression. Depression, meanwhile, can also adversely affect pain behaviors ranging from symptomology to treatment response. Pain and depression independently induce long-term plasticity in the central nervous system (CNS). Comorbid conditions, however, have distinct patterns of neural activation. We performed a review of the changes in neural circuitry and molecular signaling pathways that may underlie this complex relationship between pain and depression. We also discussed some of the current and future therapies that are based on this understanding of the CNS plasticity that occurs with pain and depression.
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Di Tella M, Castelli L, Colonna F, Fusaro E, Torta R, Ardito RB, Adenzato M. Theory of mind and emotional functioning in fibromyalgia syndrome: an investigation of the relationship between social cognition and executive function. PLoS One 2015; 10:e0116542. [PMID: 25594169 PMCID: PMC4296933 DOI: 10.1371/journal.pone.0116542] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/10/2014] [Indexed: 12/14/2022] Open
Abstract
Background Fibromyalgia (FM) is a syndrome primarily characterised by chronic, widespread musculoskeletal pain. In the aetiology of this syndrome a crucial role is played by complex interactions among biological, genetic, psychological, and socio-cultural factors. Recently, researchers have started to explore emotional functioning in FM, with their attention focused on alexithymia, a personality construct that affects the regulation of a person’s own emotions. On the other hand, the detection and experience of emotional signals from other people have only been sparsely investigated in FM syndrome and no studies have investigated the ability to represent other people’s mental states (i.e. Theory of Mind, ToM) in these patients. Here we present the first study investigating a large set of social-cognitive abilities, and the possible relationships between these abilities and the performance on executive-function tasks, in a homogenous sample of patients with FM. Methodology Forty women with FM and forty-one healthy women matched for education and age were involved in the study. Social cognition was assessed with a set of validated experimental tasks. Measures of executive function were used to test the correlations between this dimension and the social-cognitive profile of patients with FM. Relationships between social-cognitive abilities and demographic, clinical and psychological variables were also investigated. Principal Findings Patients with FM have impairments both in the regulation of their own affect and in the recognition of other’s emotions, as well as in representing other people’s mental states. No significant correlations were found between social cognition tasks and the subcomponents of the executive function that were analysed. Conclusions The results show the presence of several impairments in social cognition skills in patients with FM, which are largely independent of both executive function deficits and symptoms of psychological distress. The impairments reported highlight the importance of adequately assessing ToM and emotional functioning in clinical practice.
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Affiliation(s)
- Marialaura Di Tella
- Center for Cognitive Science, Department of Psychology, University of Turin, Turin, Italy
| | - Lorys Castelli
- Center for Cognitive Science, Department of Psychology, University of Turin, Turin, Italy
- * E-mail:
| | - Fabrizio Colonna
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrico Fusaro
- Rheumatology Unit, “Città della Salute e della Scienza” University Hospital of Turin, Turin, Italy
| | - Riccardo Torta
- Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Turin, Italy
| | - Rita B. Ardito
- Center for Cognitive Science, Department of Psychology, University of Turin, Turin, Italy
| | - Mauro Adenzato
- Center for Cognitive Science, Department of Psychology, University of Turin, Turin, Italy
- Neuroscience Institute of Turin, Turin, Italy
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